卵巢子宫内膜异位症囊肿剥除术与卵巢功能

子宫内膜异位症是女性慢性盆腔痛和不孕主要病因,好发部位为卵巢、腹膜与阴道直肠膈.腹腔镜检查手术是诊断和治疗卵巢子宫内膜异位症的金标准.年轻未育的患者术后出现卵巢早衰,是近年来出现的新问题.本研究通过文献调查,分析各种预防和治疗卵巢早衰的可行措施.     

子宫内膜干细胞与子宫内膜异位症的治疗

子宫内膜异位症（EMs）是妇科最常见的疾病之一,引起痛经、月经不调、不孕等,严重危害妇女的身心健康,影响患者生活质量。其发病率逐年升高,发病机制不清,疗效差,一直是困扰妇科医生的难题之一。最近提出的子宫内膜干细胞（SC）学说认为EMs起源于SC,EMs病灶的维持和发展是子宫内膜SC不断更新和分化的结果。因此,治疗的关键应是针对子宫内膜SC,通过靶向子宫内膜SC及其异常调节的信号转导通路来治疗EMs。这对传统的治疗方式提出了巨大的挑战,也为有效的根治EMs开辟了新的思路。     

腹腔镜手术治疗子宫内膜异位症的临床价值

子宫内膜异位症是妇科常见病、多发病之一,可引起痛经、慢性盆腔痛、性交痛和不孕等症状,严重影响育龄期妇女的身心健康和生活质量,日益受到人们的关注。以人为本,微创手术是当代医学的模式之一。本文从哲学的角度出发、以辩证的观点对腹腔镜手术治疗子宫内膜异位症的临床价值进行综述。     

腹腔镜手术治疗子宫内膜异位症的临床价值

子宫内膜异位症是妇科常见病、多发病之一,可引起痛经、慢性盆腔痛、性交痛和不孕等症状,严重影响育龄期妇女的身心健康和生活质量,日益受到人们的关注。以人为本,微创手术是当代医学的模式之一。本文从哲学的角度出发、以辩证的观点对腹腔镜手术治疗子宫内膜异位症的临床价值进行综述。     

子宫内膜异位症的诊断和治疗进展

子宫内膜异位症(endometriosis,EMT)是妇科最常见的疾病之一,是引起痛经、月经不调、不孕等证状的重要原因,发病率呈逐年上升趋势,严重危害妇女的身心健康,影响患者的生活质量。其发病机制不清,疗效差,易复发,一直是妇科研究的热点和难点。多年来随着对EMT发病机制的不断认识,使EMT的诊治得到了进一步的完善和发展。从哲学的角度以认识和发展的观点对子宫内膜异位症的诊断和治疗进展进行综述,以有助于临床上的诊治。     

子宫内膜异位症的诊断和治疗进展

子宫内膜异位症(endometriosis,EMT)是妇科最常见的疾病之一,是引起痛经、月经不调、不孕等证状的重要原因,发病率呈逐年上升趋势,严重危害妇女的身心健康,影响患者的生活质量.其发病机制不清,疗效差,易复发,一直是妇科研究的热点和难点.多年来随着对EMT发病机制的不断认识,使EMT的诊治得到了进一步的完善和发展.从哲学的角度以认识和发展的观点对子宫内膜异位症的诊断和治疗进展进行综述,以有助于临床上的诊治.     

践行患者受益的基本原则——从累及泌尿生殖系统复杂子宫内膜异位症临床处置谈起

“患者受益”作为临床处置决策的基本原则在日常的医疗工作中发挥着积极的作用。同样也在常见类型子宫内膜异位症（EM）诊疗过程中得到很好地贯彻执行。然而,对于少见的累及泌尿系的EM,由于缺乏可靠的临床循证医学证据用以指导患者具体的临床处理,把握患者利益最大化原则就显得尤为重要。怎样掌握累及泌尿生殖系子宫内膜异位症患者临床处置决策中的关键要素,尽可能为患者保留生殖能力与泌尿系统的完整性,以提高日后的生活质量。除需要详细了解患者病史特别是手术史、盆腔影像学检查、肾脏功能评估结果外,选择个性化的干预手段并对预后进行综合评估,制定最为适合的治疗方案是至关重要的。本文结合临床典型病例就此问题做一剖析。     

论子宫内膜异位症的诊断和治疗

子宫内膜异位症 (ｅｎｄｏｍｅｔｒｉｏｓｉｓ ,ＥＭＴ)是生育年龄妇女的常见疾病 ,对妇女的身体健康和生活质量有着很大的影响 ,其发生率为 4 %～ 17% ,而ＥＭＴ患者中合并不孕者约 30 %～ 4 0 %。近几十年来 ,对ＥＭＴ不孕的诊断和治疗的过程 ,也就是对ＥＭＴ不孕发病机理认识的不断深化的过程。1　对ＥＭＴ引起不孕的发病机理的探讨和认识ＥＭＴ首先于 1860年由Ｒｏｋｉｔａｎｓｋｙ在一尸解病例中记述 ,直到 192 1年由Ｓａｍｐｓｏｎ定名为子宫内膜异位症。对ＥＭＴ与不孕症之间的密切关系早已众所周知 ,但对其发病机理尚不十分清楚。重…     

子宫内膜异位症的抗血管生成治疗进展

子宫内膜异位症为良性病变,但其某些生物学行为却类似恶性行为,尤其是组织侵袭和远处种植生长的能力。尽管现在该疾病的发病机制仍未明了,但近来发现,血管发生在EMs的侵袭、种植、生长中起重要作用。因此,抗血管生成治疗的深入研究将为EMs的“靶向治疗”带来生机。为其今后能在EMs疾病中应用提供重要的理论依据。     

用转化思维指导中西医治疗子宫内膜异位症

子宫内膜异位症为育龄妇女常见疑难疾病.本文在临床实践中,先分析目前中西医各自相关理论的局限,再分别采用对方的理论视角审视己方的观察结果,得出结论认为病因病机是机体全身适应性降低导致自身原有的生理因子表现为病理作用,在生殖系统即为内膜异位的各种病症,治疗原则均不应是单单拮抗相关的病理因子,而应该调和包括雌激素在内的各种因子以增强机体的适应能力,进而设计个体化的中西药治疗方案,进行分阶段、恢复生理节律为目的,精确调理生殖激素的治疗.     

Qualitative Evaluation of Medical Information Processing Needs of 60 Women Choosing Ovarian Cancer Surveillance or Prophylactic Oophorectomy

Thirty women who had prophylactic oophorectomy (PO) and thirty women undergoing ovarian cancer surveillance (OCS) completed a one-time in-depth telephone interview exploring information gathering and decision-making processes. There were close similarities between groups, including age, race, marital status, education, menopausal status, number undergoing genetic testing for BRCA mutations, and number of prophylactic mastectomies. The majority of participants indicated overall satisfaction with their final decision. However, many described the information gathering process as frustrating and anxiety provoking. Participants in both groups expressed a need to process medical information within the context of individual psychosocial needs and personal perceptions and experiences. There were recurrent themes with regard to informational and psychosocial needs and personal perceptions and experiences that impacted decision-making process for these women. The present paper is a companion paper to Swisher et al. (J Repr Med 2001, 46:87–94) with the focus of this paper to illustrate the medical informational processing needs identified by this group of women.     

卵巢激素影响女性恐惧情绪加工的神经机制

大脑结构和功能的性别差异导致恐惧情绪加工的两性差别。女性对恐惧情绪加工受到体内雌激素和孕激素浓度的影响。近年来, 人类脑成像技术、遗传学和分子生物学的综合研究发现了卵巢激素影响女性恐惧情绪加工的神经机制。其中, 雌激素水平升高导致杏仁核活动增强, 使女性对恐惧面孔识别的准确性增加, 而孕激素水平则相反。这与女性在月经周期不同阶段对社会交往的需求和妊娠期间的自我保护机制有关。     

Family Communication and Genetic Counseling: The Case of Hereditary Breast and Ovarian Cancer

In familial breast/ovarian cancer, the information that the proband is able to supply about other family members is of critical importance for genetic counseling. This frequently requires family communication. Forty-six women attending a cancer genetics clinic were interviewed as part of a longitudinal study. Nearly all reported affected maternal, rather than paternal relatives, which may indicate lack of awareness by women with paternal histories. There was also much more communication among female relatives. Mothers, where they were still alive, were key figures in supplying family information. Although the majority of the sample contacted at least one relative regarding counseling, most named a relative with whom they did not feel able to communicate on this subject. Probands balanced the perceived obligation of passing on information with that of not causing alarm. Communication, both obtaining and giving information, was impeded by adoption, divorce and remarriage, family rifts, and large age gaps between siblings.     

循证医学与卵巢癌的治疗

循证医学(EBM)是在临床实践中通过科学的方法获得最充分的证据,并对病人做出最佳诊治决策的一门科学。目前卵巢癌的治疗还存在很多不规范的问题,利用循证医学观点来指导卵巢癌治疗方案的选择,对保留患者的生育功能、生理功能、提高生活质量有着重要的指导意义。     

Recommendation Recall and Satisfaction After Attending Breast/Ovarian Cancer Risk Counseling

This study examined women’s recall of physician recommendations as well as patient satisfaction following participation in a breast/ovarian cancer risk and prevention program. Participants were 41 high risk women who attended a cancer risk program 4–6 months earlier. Two-thirds of women who received recommendations for tamoxifen treatment and genetic testing did not recall these recommendations upon follow-up. A number of women misunderstood recommendations and a quarter of the sample recalled recommendations that were not made during the consultation. Although these high risk women were generally satisfied with their counseling visit, those individuals who received particularly complex sets of recommendations reported feeling less understood and were less satisfied with the counseling. Findings underline the importance of examining recommendation recall, in addition to perceptions of cancer risk, when evaluating the clinical implications of cancer risk assessment.     

Risk-Reduction Surgery Decisions in High-Risk Women Seen for Genetic Counseling

Women at greatest risk for hereditary breast and ovarian cancer may consider prophylactic removal of breasts or ovaries as a risk-reduction measure. This report describes uptake of risk-reduction mastectomy (RRM), risk-reduction oophorectomy (RRO), and related factors in 62 high-risk women who received genetic counseling. Seven (11%) participants underwent RRM and 13 (21%) underwent RRO. Of these women, 37% did not have BRCA testing, suggesting other factors influence decisions to undergo surgery. Women who had indicated (pre-genetic counseling) their intent not to have surgery chose not to have surgery. Information received during genetic counseling that women perceived as being most important for influencing risk-reduction surgery decisions was BRCA test result (positive or negative), followed by discussion of family cancer history. Reasons for indecision about risk-reduction surgery included genetic testing results, concerns about surgery, timing in life, and early menopause. The findings enhance our understanding of information that is helpful to women considering this surgery.     

卵巢肿瘤蒂扭转急腹症诊治进展

卵巢肿瘤可因肿物扭转、破裂、出血等而导致剧烈腹痛、恶心呕吐、甚至出现失血性休克等急腹症的表现,是妇科临床常见的急腹症之一,有时容易误诊而导致严重后果。随着医疗水平的提高及微创观念的引入,目前对一些妇科急腹症如卵巢囊肿蒂扭转的处理等在诊断与治疗方面发生了很大的变化,现综述如下。     

保留子宫动脉筋膜内子宫切除术对卵巢功能的影响

为了探讨保留子宫动脉上行支筋膜内子宫切除术对卵巢功能的影响,将90例符合条件的患者,随机分成研究组（行保留子宫动脉上行支筋膜内子宫切除术）和对照组（行筋膜内子宫切除术）,重点观察两组手术对卵巢功能的影响。对照组血卵泡刺激素（FSH）、雌二醇（E2）术后与术前相比,差异有统计学意义（P＜0．05）。两组更年期症状的发生率差异有统计学意义（P＜0．05）。保留子宫动脉上行支筋膜内子宫切除术术后近期卵巢功能影响小,远期效果有待观察。     

Illness representations and distress in women undergoing screening for familial ovarian cancer

Women with a familial or genetic predisposition to ovarian cancer are at significantly increased risk of developing the disease, and this warrants effective risk management strategies. A clinical trial of ovarian cancer screening (OCS) is being conducted to establish the effectiveness of this risk management strategy. This article reports data from its psychological partner study which aims to evaluate the psychological effects of OCS. Leventhal's Self-Regulatory Model provided the theoretical framework for understanding emotional responses to OCS. The revised Illness Perceptions Questionnaire (IPQ-R) is based on this model and the IPQ-R, adapted to the risk of ovarian cancer, was completed by women (N?=?1999) prior to screening. The original IPQ-R factor structure was not replicated but IPQ-R variables explained 14.70% of the variance in women's ovarian cancer-specific distress after controlling for age, general anxiety and depression. Negative emotional representations of ovarian cancer risk and general anxiety were moderately associated with greater ovarian cancer-specific distress whereas cognitive illness representations were weakly related to ovarian cancer-specific distress. Further analyses of data from the ongoing psychological evaluation are needed to determine the predictive utility of IPQ-R variables in explaining distress during OCS.     

Women's Understanding of Their Risk of Developing Breast/Ovarian Cancer Before and After Genetic Counseling

Many studies have reported that individuals frequently over- or underestimate their risk of developing cancer both before and after they attend genetic counseling for breast and/or ovarian cancer. Using a combination of interviews and written questionnaires, we investigated counselees' understanding of their risk of developing cancer before and after genetic counseling. We demonstrate that although 76% of the sample thought that their risk was elevated relative to women in general, only a small proportion (17%) were willing or able to provide a numerical estimate of their risk of developing cancer before they attended the clinic. Following the consultation, 43% indicated that their risk of developing cancer was lower than they had anticipated. Twenty-two percent described their risk in absolute rather than relative terms, i.e., that they would definitely (not) develop cancer in the future. The implications of these findings for further research are discussed.